Qualy #109 - How does one select the right physician as a patient？
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Summary
In this bonus episode, Dr. Peter Atiyah answers a common question: "How do I find a good primary care physician?" Dr. Atiyah has been a practicing physician for over 20 years and is a member of the New York City boroughs of Queens, Brooklyn, and the Bronx. In this episode, he talks about how to identify a good doctor, what to look for in a physician, and why you should be looking for a good one.
Transcript
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Welcome to a special bonus episode of the Peter Atiyah Qualies, a member exclusive podcast.
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The Qualies is just a shorthand slang for qualification round, which is something you
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do prior to the race, just much quicker. The Qualies highlight the best of the questions,
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topics, and tactics that are discussed in previous episodes of The Drive.
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So if you enjoy the Qualies, you can access dozens more of them through our membership
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program. Without further delay, I hope you enjoy today's Qualies.
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MD selection. I think you've received this question more than once. How do I find a good
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doctor? So what is the best way to find a really good primary care physician? Are there specific
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telltale questions, labs I should bring up with a prospective PCP? I think we covered that.
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But also to see if they've picked up a medical journal in the last 20 years.
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You know, I sort of actually had this discussion with a patient on Monday who's looking for a
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concierge, you know, primary care physician, since I'm not a PCP. Many patients come to me already with
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a PCP, but sometimes they don't and they want to have this question. So, you know, I kind of walked
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him through my mental model, which is there's no one size fits all here. You just have to decide what
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it is you need and want. So I think about availability, affability, ability, and advocacy
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as sort of the four broad pillars that you're looking for in a physician. And it's pretty much
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impossible that you'd find all of those in the same person. So what do I mean by those things? So
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advocacy is the physician who's connected and knows how to help you navigate through a storm.
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When you need to go get a colonoscopy, they know the absolute best endoscopist. And if God forbid,
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like something comes back with a positive finding, they know exactly the right surgeon and boom,
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boom, boom. And not only do they have the Rolodex, but they know how to help you get through that.
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They will be your, you know, your advocate in the system. I personally think that's very important.
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I think many people aren't actually thinking of that, but it's important to
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to sort of ask a doctor explicitly and directly about that. Ability to me is obviously, I just
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think that that's the single most important thing. I mean, in the end, yeah, bedside manner is great.
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Affability is important, but I'll never take affability over ability. You'd want both. They're
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not mutually exclusive, but don't be confused. Don't be confused by affability at the expense of
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ability. So we'll come back to how, maybe how you can assess ability, but that's important.
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And affability is like, do you get along with this person? And I think you should be able to
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get along with your doctor. I mean, I think the days of going to the doctor who talks down to you
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and is basically preaching a bunch of commandments, you know, it just doesn't make any sense. Like
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you just don't want those kinds of people around because yeah, in the end they might be the expert,
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but if they can't bring you along, then the relationship probably doesn't fit. And if I,
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if I have a patient in which I feel like I can't bring them along or I don't connect with them, I
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certainly say to them, look, maybe this isn't working, you know? And in the end you maybe need
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somebody different from me who can communicate in a way that you like to be communicated with.
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Availability is basically, or access is like, are you looking for someone that you can call 24 seven?
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And that's when people are looking for concierge docs, that's generally what they're looking for.
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There are lots of non-concierge docs though, that still have, and within the world of concierge,
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look, you've got like the $30,000, your concierge guys, and you've got the $3,000 concierge guys.
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And so you also have to be able to think about, okay, well within that, like what's the difference
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between those two? What's worth $27,000 more per year? If, if that's the, and those are literally
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like, that's probably the range that I see in New York for concierge PCP. But I guess the person
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asking this question is probably thinking mostly about ability. I think, you know, the, the question
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included something about have they read a medical journal in the last 20 years? I mean, that's a good
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question because so much of what we learn in medical school is pretty much irrelevant by the
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time we're practicing and the lag between when something becomes a finding and when it becomes
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mainstream or obvious enough that everybody's doing it. You know, I've seen that number estimated at
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anywhere from 12 to 20 years. So yeah, it seems like a pretty inefficient system. So I think there,
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you just want to talk to your doctor and say, look, how, how busy are you clinically? How much
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time do you spend reading literature? And again, I wouldn't use buzzwords like evidence. Do you
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practice evidence-based medicine? Cause what doctor is going to say no to that question? Like it's sort
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of a silly question. It's, you know, it's like, um, so it's mostly just trying to inquire about the
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curiosity of the person, their passion around learning. Cause I think in many ways, if you're not
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learning quite a bit as a doctor, you're probably not practicing great medicine. If you're not sort
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of trying to get smarter on diagnostics or, you know, advancements in the field, then I, you're
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probably stagnant. And it's not to say that a doctor who's stagnant can't do great work on certain
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things, but for most people, they don't want to have like six doctors in their life. You know, they sort
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of, you want to go to one person. So I think that's how I sort of think about that. Unfortunately,
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I'm not really a fan of a lot of the labels that people put on like, well, I, you know,
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I practice functional medicine or I've, I'm part of, you know, this organization or that
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organization. I just, I don't know. I think in the end you got to just evaluate the person
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individually regardless of those, those features. And, um, I don't know. I don't know if that answers
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the question, but. I think so. I think one of the things that I was thinking about is people will
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ask people be relatively specific and they'll say, I live in Boise, Idaho. Do you know a good
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doctor there? You may or may not know a good doctor there. However, it brings, it probably
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brings up the point that if you can get a referral from somebody that you really respect and think is
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a great doctor and knows their stuff, that a referral probably would be pretty valuable there
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too as well. But it's very hard probably to refer somebody if you're in your own practice as a
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doctor to really vouch for somebody else across the country. Yeah. I mean, my, my, my ability to do
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that is, is if it's, if it's going to happen, it's going to be by luck. It's going to be,
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I already have a patient there and they've got a doc who I've entered. Like I, you know,
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a patient in Seattle who's got a, an amazing PCP up there who I won't name now or else he'll get
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inundated with a million people. But frankly, I think his practice is probably full, but every time
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I've had a patient move up to Seattle, it's like, that's going to be your doctor. Cause the guy's
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like, he is the epitome of what a great PCP is. And I, I love reading his notes. I just,
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I love interacting with him and I love that, you know, we compliment each other. In other words,
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there's a whole bunch of things that I do that, you know, look, he sort of knows a little bit about,
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but he wants to know much more about lipidology and cancer screening and, you know, some of the
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exercise stuff we're doing. But then there's a bunch of stuff he does that I, like his knowledge of,
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you know, when the patients travel to this part of the country, you got to be aware of this
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particular parasite that can show up and here's how we're going to vaccinate you against this.
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And here's how we're going to, you know, you were in that cave in Texas. Well, you're very
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susceptible to this kind of thing. And, and just, you know, someone's got like a, a, an HSV flare and
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like he knows all of the tricks. And so that's probably the easiest way for me to refer people
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is that I've worked with the doc directly. Going back to the point though, I don't think people
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should be afraid of this process taking a while. In other words, if you, if you go down the path and
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you find somebody and you think this is going to be my doc and, you know, six months in, you don't
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like him or her, do it again, keep doing it, keep doing it. And a lot of the questions you ask,
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the doctor's reaction to those questions is probably a litmus test. So if, if you sense that a doctor is
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put off by a curious patient who's showing up wanting to be actively involved in their health,
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well then you don't want that doctor. You don't want someone who's intimidated or put off by your
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interest and obsession in this stuff as a patient. Hope you enjoyed today's special bonus episode of
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